Individual
SUSANNE M IADANZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
483 W. SEED FARM RD., SACATON, AZ 85247
(602) 528-1340
(602) 528-1296
Mailing address
P.O. BOX 115, MEDICAL STAFF SERVICES/CREDENTIALING, SACATON, AZ 85247-0115
(602) 528-1340
(602) 528-1296
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
894385
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN
—
Enumeration date
07/10/2006
Last updated
05/21/2020
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